Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
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Monday, February 06, 2012

We are taking a break from our normal forensic programming to bring you this guest post from Jesse, a review of the film "A Dangerous Method." ---Clink

Another psychiatrist and I went with our spouses. We all hated it. There were at least three levels on which I considered the film, the first being whether it in fact is a good film, the second relating to what it shows about Freud, Jung, and the birth of psychoanalysis, and the third what it shows about a psychiatrist getting involved with his patient.

A Dangerous Method purports to show Jung, the protagonist, treating a young (and of course beautiful, played by Keira Knightly) Russian Jewish woman named Sabina Spielrein, who was brought to his clinic for treatment of her hysteria. It is quite obvious from the outset that he will fall in love with her, and we are not disappointed, but the predictability and lack of drama in the film are striking. Spielrein gets better and wants to become a physician and analyst herself, which she does (historically, her most famous analysand was Jean Piaget).

We see a little of Freud, stiff and priggish, but quite adamant on maintaining the scientific stature of psychoanalysis and opposed to Jung’s efforts to bring in parapsychology. It is hard to imagine a less sympathetic picture of Jung, and as one who knows relatively little about him I can just say that I hope this film’s portrayal is a strong dramatization: unfeeling, narcissistic, and breaking every rule that has been standard in our field since its inception.

Sabina has been abused by her father by being beaten, which she acknowledges led to sexual arousal. Her symptoms remit as she became able to talk about it. Of course the very worst thing for this woman would be to reproduce that trauma with her psychiatrist, but that is exactly what Jung repeatedly does. The director switches (again quite predictably) between scenes of Sabina being beaten by Jung prior to sex to scenes of Jung’s beautiful and virginally white-clad wife, loyal and forgiving, who tells Jung haltingly that she disappointed him by having given birth to a girl, but will do better next time.

Of course Sabina falls in love with him. You do understand that it is transference. But he soaks it up and wallows in it. For a patient who has been sexually abused and beaten by her father everything Jung does is the worst it could be.

No viewer has any sympathy for him. He is without feeling except for himself. No guilt. No regrets.

Now, if the film really taught us something about psychoanalysis! But it doesn’t. It uses the language but throws off profoundly important concepts with the ease of a ten year old telling you that E = mc2, and with equivalent understanding. Spielrein herself made some important contributions, and Jung was one of the most famous psychologists in the world, but how he got that distinction (rather than ostracism and shame) is anyone’s guess.

So the more you know about psychoanalysis and good drama the more you will hate this film. The more you understand that a patient having a sexual relationship (and even more a perverted one) with a psychiatrist causes profound and lasting damage, the more you will feel that a film that makes the relationship appear harmless is itself causing serious harm.

Jesse, what's with this freudian priggishness? Is "perverted" a clinical term nowadays?

I haven't seen the movie, but I'll try a little exercise in reframing anyway.

Child was damaged by abusive father, grows up into a kinky woman. She meets a man she can act out her fantasies with in the context of an adult BDSM relationship. Ultimately she moves on to become a physician and respected psychoanalyst, marries and raises a family, maintains professional relationships with her ex-lover and his respected colleague, and is ultimately murdered with her children by the SS at age fifty-seven.

There are worse things than being kinky.

Given that she seems to have led an interesting life, it seems to me that the most appropriate target of revulsion here is the SS.

Why can't they seem to do even the minimum of research to at least show that such a relationship is harmful? UGHHHHH.

Me, I'm curious about the new TV show Awake starting early March, about a guy who has lost either? his wife or his son in a car crash, and he goes to a psychiatrist in both realities he inhabits; one is a dream, (supposedly? probably . . . it'd suck if this show eventually said both realities existed and were paralell universes, would be interesting but would avoid him having to deal with his problems lol unless he had to choose one reality). He can't even tell when he's awake, which reality is real and which isn't.

But, as one teaser commercial has the patient saying, "I'm not interested in making any progress" (in that area? it's implied, referring to having to pick or figure out which "life" he's living is the real one). Talk about therapeutic resistance lol, but it seems like it will be an interesting show.

I bet you guys wonder how the shrinks will be portrayed, since they'er a major part of the show; one is the oriental shrink dude from Law & Order, I think, and the other is a 40-45-ish woman.

Anyway, sorry the film sucked, and that it pushed harmful ideas about inappropriate therapeutic relationships.

@Alison Cummins: Actually, the fact that in real life Sabina did so well personally and professionally is evidence that what was portrayed in the film did not actually happen. Women who have had the type of experiences Sabina did end up very damaged. This is the reason that professional boards rightly take action against professionals who act as Jung did in the film.

Jung is portrayed as a cold scoundrel, as much to his wife as to his patient.

Jung was ten years older than Spielrein, so 28 to Spielrein’s 18 when they first met. He was newly qualified.

Whether or not they had genital intercourse, it’s quite clear that they had what is these days called “an emotional affair” that continued five years after her release from the psychiatric clinic. His letters to her make it obvious that it was not one-sided.

He behaved badly towards her, telling Freud that Spielrein was fantasizing and lying to get revenge.

Do you have evidence that none of this is true, beyond your conviction that “Women who have had the type of experiences Sabina did end up very damaged”?

(I’m a little confused by this last statement. Spielrein had the kinds of experiences that Spielrein did, by definition.)

@Alison, I meant that if the events as shown in the film (not what is recorded historically) were true it would likely have damaged Sabina severely. An emotional affair is quite different from what was portrayed in the film, which was a replication of what she suffered, and/or fantasized, from her father. Women who engage in these acts with their therapists are seriously hurt by it as a rule.

I am using perversion in the sense of sexual orgasm, as a goal, as from other than heterosexual intercourse. I'm using it in the historical sense, not the modern one.

Jesse, with regard to your statement that “Women who have had the type of experiences Sabina did end up very damaged”, I am not about to state whether this did or not happen to the woman in question. I do want to say that there are women who have had the experience of being abused by fathers and later by other men, including therapists, who actually do well personally and professionally. That is not to say they were not harmed on many levels. The whole notion of survivor, as opposed to victim, exists not only because it is empowering but because so many women and men have survived horrific experiences and gone on to do well in life. I know of Holocaust survivors who had families and did very well professionally. For them , as well as women or men who have survived horrific abuse, I prefer not to use the word damaged. That is often used against us--the whole damaged goods issue. I prefer to say that someone suffers from the effects of something but at the same time, some people are very resilient and do overcome their past, at least in the eyes of those who encounter them. It truly is possible to be haunted by the past yet function very well in society. Perhaps some people who have gone through a terrible event ,or series of events, have the sharpest survival skills of anyone.I cannot imagine walking into a psychiatrist's office to say that I want to have therapy for an abusive past only to be told that i could not possibly have been abused based on my level of functioning, education, marital status, having raised a family, you name it.

I'm seconding (thirding?) the objection to the description of the described sexual relationship as "perverted." A frank ethical violation which exploits an abused woman -- absolutely, so I guess the comment could have referred to the relationship which was (a) sexual and (b) a perversion of healthy therapeutic relationship dynamics and pretty much all the ideals of the profession. In context, however, it seems to refer not to the existence of the relationship itself as perverted, but the particulars of their sexual activities, and that's what I find problematic.

Any sexual relationship between psychiatrist and patient would be unethical and harmful, but in a NON-therapeutic context, either party could enjoy a mutually fulfilling sexual relationship with a little kinky fantasy fulfillment and remain well-adjusted.

The film does not show kinky fantasy fulfillment. It shows him slapping her very hard repeatedly. Just what she described her father having done.

An emotional affair is a very different thing. It is the repetition of the childhood abuse, in a patient who had suffered so terribly as a result, and from the therapist, that is what is shown in the film.

@HiFunctioningWoman: I actually agree with everything you wrote, but am very glad that a woman said what you did. I'm afraid that if I had written what you did there would not be enough tar and feathers on the east coast for me. There are always exceptions to the common experience, and in fact there are well known cases of women, very successful ones, who married their analysts. Those cases, and emotional affairs, are far different from what was shown in the film.

I said there is evidence that what was shown in the film did not happen, not that it is absolutely proven. Think of the converse: if a person suffers from symptoms that frequently stem from abuse it can be evidence that the abuse happened. Not proven. Simply something that, for instance, I as a psychiatrist who does treat numbers of people who relate stories of abuse take into account in understanding their symptoms.

If I understand you correctly, a sexual relationship between a therapist and a woman patient is especially damaging if it includes cunnilingus in addition to heterosexual genital intercourse. (And yes, I have noticed that you emphasize that the people who are damaged are specifically women, not simply patients of any sexo or gender; and that you refer to Carl Jung by his family name and Sabina Spielrein by her first name.)

The notion that orgasm from any technique other than heterosexual genital intercourse is inherently damaging is bizarre.

Also, if I understand you correctly, emotional affairs between psychiatrists and patients are not damaging. Again, I find this bizarre.

Whatever Jung and Spielrein’s relationship involved, he lied about it to Freud and blamed it on her. At some level he appeared to believe that the relationship was inappropriate.

Jesse:“The film does not show kinky fantasy fulfillment. It shows him slapping her very hard repeatedly. Just what she described her father having done.”

Actually, I would say you perfectly described kinky fantasy fulfilment in this context. It is exactly what I understood from your review.

Have you ever read anything by Pat Califia? I recommend Macho Sluts for insight into perversion and sadomachochism.

Also Penelope Trunk is interesting. She is definitely trouble, has been “damaged,” but actually has a fairly successful life.

Stories based on her childhood: http://www.altx.com/hyperx/sss/sundyi.htmhttp://www.altx.com/hyperx/sss/fiftn.htm

What Penelope Trunk does now:http://www.penelopetrunk.com/

I don’t think she had unprofessional non-genital relations with a psychiatrist, but somehow I think she would have been just fine if she had.

Fantasizing that any psychiatrist has enough power to destroy any woman on the planet is a litte bit on the narcissistic side. As I said above (in a comment that didn’t make it through) I agree that sex with a patient is a serious issue.

What I can’t accept is that psychiatrists and perverted sex have magical destructive powers that can render any woman permanently unfit for school, work or any kind of human relationship. That smacks of magical thinking to me.

I I had to pick one line to distill what I said, it would be:It truly is possible to be haunted by the past yet function very well in society. I am not clear on why you are happy that a woman said it or why it would be grounds for tar and feathering if a man said it. I actually do not know much about Jung at all, and I do not know what he did or did not do to the woman in question. It doesn't matter for the sake of what I was saying. I would like to say I am glad you agree with what I have said but I am not certain that you read what I said the way I meant it to be understood.

I agree with everything Jesse said. It is perverse. A patient is paying a therapist/psychiatrist for help not a date, and a patient ought to be able to expect that the person they're seeing has some ethics. Thankfully, most are ethical but those few who aren't do a lot of damage.

@HiFunctioning Woman: again I agree with you that "It truly is possible to be haunted by the past yet function very well in society." I know of people who went through Auschwitz and of whom your comment applies. Your comment expresses that truth eloquently.

As to my remark about tar and feathering it is a bit tongue in cheek. It expresses that your remark was more complete and correct than mine, but that frequently here on Shrink Rap there have been certain things that would be impolitic if said by a doctor, a psychiatrist, or, as in this case, by a male psychiatrist.

There may be implications of what you wrote that you didn’t intend, but it’s possible they are there anyway.

Of course it’s also possible that I am completely misunderstanding you, because taken together some of your statements seem inconsistent to me. Specifically:

“[T]he fact that in real life Sabina did so well personally and professionally is evidence that what was portrayed in the film did not actually happen.”

“I agree with [HiFunctioningWoman] that “It truly is possible to be haunted by the past yet function very well in society.””

Those two statements seem to contradict one another.

You do clarify later saying, “I said there is evidence that what was shown in the film did not happen, not that it is absolutely proven.” However, “evidence” is a very strong word. In this context I would say instead that Speilrein’s doing well is “consistent with” a more conventional relationship. Lots of people do well, including people with horrific pasts or twisted presents. The fact that someone does well tells us very little about the conventionalality of their emotional histories.

“[T]here are well known cases of women, very successful ones, who married their analysts. Those cases, and emotional affairs, are far different from what was shown in the film.”

How do you know? Are emotional affairs always positive or benign? Are the people involved in them always high-functioning? Are marriages always happy? Perhaps you know for a fact that the high-profile marriages you know of were in fact drama-free. Fine. But then you define an emotional affair as a relationship not conducted with one’s psychiatrist and not containing elements of violence, drama or recapitulation of the past. Obviously by that definition, Jung and Spielrein were not depicted in the movie as having an emotional affair. My definition of an emotional affair is much simpler: it’s what an affair would be but without the orgasms. In my world, orgasms are not a prerequisite for abuse, so it’s perfectly possible (in my world) that they could have been obsessed with one another and that he could have been emotionally and physically abusive even if there were no orgasms involved.

I realize you are focussing on the violence that Jung directed at Spielrein. I don’t think that the movie was depicting a modern, consensual BDSM relationship with safe words. My reframing involved a story that if Spielrein herself were kinky, Jung’s violence toward her would have made sense in a sexual way allowing her to participate in the relationship without being destroyed.

My story was that Spielrein could have been resilient, that she could have known what she was doing, that she could make lemonade. This version of Spielrein is consistent with the theme of her doctoral thesis and the fact that she became quite accomplished.

I have no idea whether Jung hit her, but we do know that he treated her badly. None of us knows whether they engaged in genital intercourse, but we do know that they were explicit about their sexual attraction for one another. I don’t see that adding genital intercourse to the mix would have added much to the awfulness; and whether his violence towards her was physical in addition to emotional is unlikely to have made much difference either.

Psychiatrists should not be visiting patients in their homes and telling them how attracted they are, and they shouldn’t throw patients under the bus. This did happen to Spielrein, though the details will never be known.

And yet she did well.

To me this is not evidence that Jung behaved at all acceptably towards her, because we know he didn’t. It’s evidence that she was resilient and a survivor.

There is so much in what Alison wrote that perhaps I should blog on the subject. In the meantime let me address this: "What I can’t accept is that psychiatrists and perverted sex have magical destructive powers that can render any woman permanently unfit for school, work or any kind of human relationship. ."

Alison, I agree with what you wrote. The problem I was addressing is not any particular action/act/relationship in itself, but this: a patient often comes into therapy because of certain events that have occurred in his/her life that have been traumatic and have led to symptoms and suffering. In therapy there might be some attempt to understand those events and find ways of overcoming the lingering effect they still are having on the patient's life.

If the therapeutic relationship contains elements which in fact replicate the original harm, leaving the patient feeling responsible for it and even more guilty and fragile, with an increase in symptoms, then the treatment no treatment at all.

In the film this is what occurs. The worst of the abuse from the father is replicated by the therapist. Many times over, in various ways.

I hope what I am saying is clear enough. If not, I may blog on it in the future. Perhaps seeing the film will make clearer what I am saying.

There is one scene in the film that makes clear the vastness of Jung's (the film Jung! Not the real Jung) selfishness. He and Freud are eating a formal dinner. The server presents a plate of meat, and Jung takes a huge serving, perhaps 70% of everything on the large platter, and starts eating a huge piece of meat. The camera turns and shows that there are about eight other guests at the table, looking at him wide eyed! Nothing much for them! And that is how he treats Sabina and his wife. Yuk.

Alison's comments are excellent, and it is unfortunate that my answers can only address a part of the questions asked.

Yes, there are many people who have suffered abuse in multiple forms yet went on to live outstanding, accomplished lives. Yet they may still carry the harm they suffered with them. As physicians we are attuned to the harm. A surgeon may through total neglect cause the loss of a patient's finger, and that patient may go on to win the Olympics or write a great novel. We do not say that no harm occurred. The surgeon should be censored.

In the movie Sabina was betrayed by her psychiatrist in multiple ways. He gained her trust, but then betrayed it. Her true life accomplishments are outstanding. In my experience those women or men who have had such experiences carry the harm from it for many years, and it colors their relationships with others.

So I was speaking to the film, and what might have happened to a patient treated as Sabina was. What Alison says is just. It also might be that in life her own relationships, with men, her colleagues, and children were damaged by her experience. Maybe not. There are many possibilities. My own views are from having treated women who who were seriously harmed emotionally by having had relationships with their doctors.

Yes, a relationship with a psychiatrist that carries out the patient's wishes through fantasy can be as harmful as a physical one, but in general that is not the case. A sexual relationship can (can, not always!) be felt by the patient as akin to incest, which is less likely in a strong friendship or "virtual" affair. There are so many possibilites.

This is such a powerful subject, perhaps some of the readers would like to submit blogs of their own for consideration by the Rappers!

... also Jesse, I understand that you feel strongly because of the damage you have seen done to your patients. I don’t doubt it’s real. Psychotherapy is inherently dangerous because the client no longer trusts their own judgement — I’ve experienced the horrors myself. Adding the weight of an inappropriate sexual relationship obviously increases the risk.

This is a very interesting blog. I experienced a shocking and traumatic boundary violation with a doctor who was not a shrink. But in Australia, at least, our medical boards are completely useless. I could not understand why the board could not see what I knew to be true. When I eventually got my medical file through Freedom of Information, I saw that he had cut and paste my file like some kindergarten kid. It was SO OBVIOUS but no one at the board asked the obvious questions. I can tell you that there is nothing quite like being retraumatised by a board that is set up to 'protect the public and guide doctors'. I don't believe in conspiracy theories, but I understand them better now! I can see why so many people here believe that the board is actually set up to protect doctors and guide the public AWAY from the truth. There is a very real problem with keeping doctor/patient boundaries. I am beginning to think that it would be much better if doctors were simply viewed as plumbers and builders, and not be required to keep any particular boundary. After all, perhaps they only have the power because of some outmoded perception about education. In the days of the original oath, very few people could read or write, and the few and selected 'educated' therefore had immense power over the masses. But that's no longer the case any more. As my mate in the country said to me, "I will call my local doctor 'Dr.' Brown when he calls ME "Farmer" Sam! I'm from a fourth generation family of medicos and having seen these old blokes drunk in their clubs over the years, I don't have any illusions about them. But, on the other hand, I was brought up to do EXACTLY what the doctor ordered, and that was hard wired so deeply within me that I couldn't move despite knowing what was happening to me.